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Nov. 9, 2007 -- When faces sag with age, there may be an architectural
reason for it -- and possibly an architectural fix, too.

It's all about the bones, according to Michael Richard, MD, and Julie
Woodward, MD, of Duke University Medical Center.

They studied head scans of 100 patients treated at Duke University Medical
Center over the past three years.

The patients fell into four groups:

25 women aged 18-30

25 men aged 18-30

25 women aged 55-65

25 men aged 55-65

Foreheads were more prominent and cheekbones were less prominent in the
older patients.

"The facial bones also appear to tilt forward as we get older, which
causes them to lose support for the overlying soft tissues," Richard says
in a news release. "That results in more sagging and drooping."

Those changes appear to be more dramatic in women, the study shows.

Richard suggests that cosmetic surgery to lift
sagging skin may be more about the face's
bony framework than the skin itself.

"Our focus has always been on tightening and lifting the soft tissues,
skin, and muscle in an attempt to cosmetically restore patients' youthful
appearance. ... It might actually be better to restore the underlying bony
framework of the face to its youthful proportions," says Richard.

But it's not just about looks.

"One of the big risks of facial surgery is the potential for hitting the
facial nerve, which could cause paralysis," says Richard. "If we can
move the focus to the bone surface, away from that nerve, we may create an even
safer, less extensive surgical procedure than the ones we perform
today."

Richard presented the findings today in New Orleans at the American Society
of Ophthalmic Plastic and Reconstructive Surgeons' fall scientific
symposium.